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Salvage of foot with extensive giant cell tumour with transfer of vascularised fibular bone graft.

Tharayil J, Patil RK - Indian J Plast Surg (2011)

Bottom Line: After excision his foot was reconstructed with vascularised bone flap.Graft united early and showed excellent remodelling because of good vascularity.We feel that this method deserves consideration as a last attempt to salvage functional foot in disease like this.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Lakeshore Hospital, Cochin, India.

ABSTRACT
Though giant cell tumor is not uncommon in young adults, simultaneous involvement of multiple mid-foot bones is very uncommon and very difficult to treat. For reconstruction of large segmental bony defects following tumour excision, free vascularized bone graft is an excellent surgical option. We report a case with extensive involvement of all the tarsal bones and metatarsal bases in a young adult. After excision his foot was reconstructed with vascularised bone flap. We were able to save his foot after a wide local excision and reconstruction with free fibula graft. Graft united early and showed excellent remodelling because of good vascularity. We feel that this method deserves consideration as a last attempt to salvage functional foot in disease like this.

No MeSH data available.


Related in: MedlinePlus

Intra-operative picture showing exposure of tumour-preserving vital structures
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Figure 5: Intra-operative picture showing exposure of tumour-preserving vital structures

Mentions: The patient was explained regarding the high possibility of recurrence and possible malignant transformation. He was also explained about the difficulties in the reconstruction if it was to be attempted, like loss of contour, loss of ankle, inter-tarsal and tarso-metatarsal joint functions and possible difficulties in walking. As the patient was reluctant to accept an amputation, we decided to perform a wide local excision and reconstruction with double-barreled free fibula. As the posterior half of the calcaneum was spared, the excision was planned as shown in Figure 3a. Figure 3b and c show the procedure till the removal of the tumour, preserving all the tendons, neurovascular structures and the skin through the medial and lateral incisions. After adequate surgical clearance, vascularised fibula (24 cm) was harvested from the opposite leg and was doubled up on its periosteal blood supply. The fibular struts were placed between the remnant of the calcaneum and the shafts of the first and third metatarsals, and stabilised by K-wires to maintain the length of the foot [Figure 3d and e]. The foot was stabilised in a neutral position using an external fixator frame [Figure 3e]. No attempt was made to fix the fibular struts to the tibia. The fibula was revascularised by anastomosing the peroneal vessels (recipient) to the anterior tibial vessels (donor).


Salvage of foot with extensive giant cell tumour with transfer of vascularised fibular bone graft.

Tharayil J, Patil RK - Indian J Plast Surg (2011)

Intra-operative picture showing exposure of tumour-preserving vital structures
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111110&req=5

Figure 5: Intra-operative picture showing exposure of tumour-preserving vital structures
Mentions: The patient was explained regarding the high possibility of recurrence and possible malignant transformation. He was also explained about the difficulties in the reconstruction if it was to be attempted, like loss of contour, loss of ankle, inter-tarsal and tarso-metatarsal joint functions and possible difficulties in walking. As the patient was reluctant to accept an amputation, we decided to perform a wide local excision and reconstruction with double-barreled free fibula. As the posterior half of the calcaneum was spared, the excision was planned as shown in Figure 3a. Figure 3b and c show the procedure till the removal of the tumour, preserving all the tendons, neurovascular structures and the skin through the medial and lateral incisions. After adequate surgical clearance, vascularised fibula (24 cm) was harvested from the opposite leg and was doubled up on its periosteal blood supply. The fibular struts were placed between the remnant of the calcaneum and the shafts of the first and third metatarsals, and stabilised by K-wires to maintain the length of the foot [Figure 3d and e]. The foot was stabilised in a neutral position using an external fixator frame [Figure 3e]. No attempt was made to fix the fibular struts to the tibia. The fibula was revascularised by anastomosing the peroneal vessels (recipient) to the anterior tibial vessels (donor).

Bottom Line: After excision his foot was reconstructed with vascularised bone flap.Graft united early and showed excellent remodelling because of good vascularity.We feel that this method deserves consideration as a last attempt to salvage functional foot in disease like this.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Lakeshore Hospital, Cochin, India.

ABSTRACT
Though giant cell tumor is not uncommon in young adults, simultaneous involvement of multiple mid-foot bones is very uncommon and very difficult to treat. For reconstruction of large segmental bony defects following tumour excision, free vascularized bone graft is an excellent surgical option. We report a case with extensive involvement of all the tarsal bones and metatarsal bases in a young adult. After excision his foot was reconstructed with vascularised bone flap. We were able to save his foot after a wide local excision and reconstruction with free fibula graft. Graft united early and showed excellent remodelling because of good vascularity. We feel that this method deserves consideration as a last attempt to salvage functional foot in disease like this.

No MeSH data available.


Related in: MedlinePlus